HomeMy WebLinkAbout900 DOGWOOD ST - Building Permitsr
(714) 754-5273 • Fax (714) 754-4856 • �wwcci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626
BUILDING PERMIT
JobAddress: 900 DOGWOODST
Suite:
Vicinity:
Parcel Number: 42252119
Applicant: HERNANDEZ, ERNESTO P
Address: 900 DOGWOOD ST
COSTA MESA, CA
Owner: HERNANDEZ, ERNESTO P
Address 900 DOGWOOD ST �
Conlractor.
Address:
2ip:
Arch :
Address:
COSTA MESA, CA
Phone:
Zoning:
Phone: 949-642-7390
Zip: 92627
Phone:
Zip: 92627
Phone:
License:
Eng:
Address:
Status: ISSUED
Applied: 04/20/2001
Issued: 04/20/2001
ISSUED BY: l,�
Phone:
Zip: License: License: '
SCOPE OF PERMIT
TEAR OFF COMP. SHINGLES , 1 151B FELT AND 25 YEAR COMP. , , `
Plan Check: $0.00
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
� �,
SETBACKS. �-� � ' ' _
MAIN STRUCTURE Front 0- 0 � Rear 0. 0
ACCESSORY Front 0. 0 � Rear 0- 0
PARKING Existinq: 0 � Required: 0
NOTES:
FEE SUMMARY
PLANNING & ZONING
LeR 0- 0
Left 0- 0
Proposed: 0
Calc Valuation: $z,soo.00
Claim Valuation: S2,aoo.00
�
%i %- . . %�/
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Right � 0- 0 �' �� %
Right' �0-0- � "
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. '
I INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspections and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration. of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zansa6 (erool
WORKERS'COMPENSATION DECLARATION: �
1 hereby aHirm under penalty of perjury one of the following declarations: � • '
❑ I heve and will maintein a cenifiwte of consent m self-Insure br workers' compensation, as provided for by section 3700 of the Labor Code, for ihe pertortnance ol the
work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of ihe Le6or Cotle, for ihe pertortnance of Ihe work for which ihis permit is issued.
My workers' compensalion Insurance carner antl policy number are:
Carrier: Poticy Number:
(This secfion need not be complefed il the permit is valued ef one hundred dollars ($100) or less.)
❑ I certify Ihat in the pedormanca of the work for which this pertnil is issueQ I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cali}ornia, end agree that if I should 6ecome sublect to the workers' compensetion provisions of Section 3700 of the Labor Code, I shall torlhwith
Comply with ihese provision5.
Applicant Signature: �ate:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHQ� SUBJECT AN EMPLOVEP TO CRIMINQ PENALTIES AND CIVIL FINES UP TOONE HUNDRED
TIiOUSAND OOLLARE ($100,00pf, IN ADDITION TO THE G�T OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOq IN SEGTIOtJ 3106 OF THE LABOR CADE, IMEFEST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Code, an0 my license is in full
force end eHect. Lic. q Class N
ComractoYs Signawre: Date:
CONSTRUC710N LENDING AGENCY:
❑ I here6y aHirtn ihat there is a consimction lending agency for ihe pedormance of the woB for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lentlar's Name: Lender'S Address:
Signeture:
OWNER-BUILDER DECLARATIONS:
Date:
I herehy etlirm ihat untler penalty of perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reeson (Sec. 7031.5, Business and Protessions
Cotle: Any ciry or counry which reQuires a pertnit to construct, alter, improve, tlemolish, or reDair any structure, pnor to its issuance, also requires the applicant for such permit
to file a signetl statemem that he or she is licensed pursuant to the provisions of ihe Contreaors License Law (Chapter 9(commencing with Section 7000) of Division 3 ot ihe
Business and Proteuions Code) or Ihat he or she is exempt therefrom antl the basis tor ihe altaged e:emption. Any violation of Section 7031.5 by eny applicant for a pertnit
subjects Ihe applicant to e civil penelty of not more than tive hundred dollars ($500).):
❑ I, as owner of ihe property, or my employee5 wi�h wages es their sole compensatlon, WILL DO 7HE WORK, and the structure is not intended or oHered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to en owner of property who builds or impmves ihereon, and who dces such work
himseN or herself or ihrough his or her own employees, provitletl ihat such improvements are not intended or oHered for sale. If, however, ihe builtling or improvement is
sold within one year of completion, the owner-builder will heve Ihe burden of proving iha� he or she did not build or improve tor purpose of sale.).
❑ I, es owner of lhe property, Bm E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo constmct the pmject (Sec. 7044, Business and Pwfessions
Cotle: The contrectors License Law does no� apply to an owner oi property who builds or improves ihereon, and who contracts for such project wtlh a contractor(s)
�license pursuant to ihe Contractors License Laws.).
0/I em exem� untler se�c. Business antl Professions Code for ihis reason:
Siqneture:_���Li ' � " Date:` .�/ 'ZD ^O
`^--
OwnerlDvenfiedbydmerslicense. �Yes ❑No �-DrivefsCiceriseNo. ��Expires:
Venfication of Ownership by (type ot tlocument,-I�e. - pmperty ta: bill or deetl)--- --- �-'� -� _
DIVISION OF INDUSTRIAL SAPETV PERMIT CEATIFICATION:
❑ 1 hereby certify �ha� no exravation five (5) or more feat in depth into which a person is required to descend, will be made in connection with work auihorized by ihis
permit, and that no building stmcture, scaffolding, falsework, or demolition or tlismantling thereot, will be more than thirty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
34i, Title B, Calitornia Aaminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit fmm the Division of Industrial Sefey, as notetl a6ove, unless such person has a
pertnit to do such work from the division.
Signature: Date:
Division of IndusMal Safery Permit Number.
CERTFlCATE OF COMPLIANCE AND AIfTHORILUION.OF EN7RY: I certify under penalty of perjury ihat I have read ihis epplication and state ihat ihe information given is
correct. I egree to comply with ell state laws and ci�y ordinances relating to building consimction, end authorize represenia�ives ot �he Ciry of Cos�a Mesa to enter upon ihe
ebove-descnbed propetly for inspection purposes. I agree not lo occupy or a�low occupancy ot any building authorized by this permit until final inspection.
J Y-' ZC� •-!� /
Signature egalOwner(s) -� _Date
And/Or Aut�orized ApPlicant Date
COOE t INSGECTONTYPE
1616 Fizetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaininq W sll
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
Q�1jF' INiITIRLS
. Q —O / , a�l .
�v_4yR..
COOE I INSPECTION TYPE
206 Final Mechanical
208 Final Plum6ing
2�0 Finai eieciricai
21? Final Ftre Prevention
220 Final Planning Appmval
222 Final Site
250 Final Builtlin<yOccupancy
DRTE
I A
PFOJECT ADOflESS: 9OO DOGWOOD ST
�OWNEfl'S NAME: CRULL JAMES L TR
RDOflESS: P � B�X 1833
PINETOP,AZ 85935
ABCHIENGINEEP:
aooxess:
NEG.NO.:
UNIT:
uxiT:
PEHMITTEE: HAI�LE DEVELAPMENT ( 714 ) 731-3780
aoosess: 39 CARRAGE WY
POMONA CA 9172'7
LICENSEU CONTflALTOP �ECIAHpTION: I here�y allirm that I am licensetl unaer D�ovisions o� Chapter 9(commencing with Sec�ion
7000� oi oivision J al �he Business antl Pwiessions Code, anG my license is in full force anG eifect. n
cirruc g35628 STpTELIC�8160���g
Dale:t �—'/� — � Z S�gna�ure: _ t/_ 7
WORKEflS' COMPENSATION �ECLABATION: I hereby aflirm avi ceni icate of conse o sel4insure or a cenificate o� Workers'
Compensalion Insurance. or a cer�tlietl copy thereol (Seciio 3804 Lab. C) '
POIICY NO.: EXP. OPTE: '
comvaxv:
❑ Ce�ilietl capy is hereby fumishe0. ❑ Cenifietl copY is IileU wilh �Ae ciry Building Division.
'e: Applicant:
aMPTION fflOM WONNEPS' COMVENSPTION OECL�MTION: (This seclian need noi be completed if the permit is tor one hundred ($100) ar less�,
i cerlify �ha� in Ihe pedormante ol �he work loryfiich this permi� is issue I shall not emplo ny person' an man e so as to became
Subleci lo Ihe Worke,rs' /Compensa�iion law�s,6i Calilomia. ����� . — /
Date: � ��,LG ' Signa�ure:
NOTICE: tl, alter making Ihis tleclaraiion, you s�ould bec me ubleci to the Workers' mpensation pmvisions of �he LaOor
CoEe. you mus�fo�hwith compry wilh 5uch provisions or�hi5 permit shall be Oeemetl revoked.
CONSTXUCiION LENOING RGENCY: I Aereby aHirm Ihai �here is a consimction lending agenty for Ihe pedormance o� Ihe work (or
whic� Ihis permii is issue0 (Section 3097. Civ. C). "
LENUEfl:
FODPESS:
OWNEfl BUILDEB DECIAPATION: I hereby aifirm Iha� I am exempt �mm Ihe Contractors' State License Law lor �he tollowing reason
(Seciion 7�31.5 Busines5 ana Professional CoOe: Any ciiy o� couNy which requires a De�mi� t� construcl, al�er, impmve, Jemolish, or
repair any simcture. o�ior to its issuance, also requires ine apDlicant for such permit to lile a signe0 statemen11ha1 he/sne is licensea
pursuam m �he pmvisions of I�e Contracmrs' S�a�e License Law (Chapter 9(commencing wilh Section 7000) o� Division 3 0� the Business
antl Pmlessians Catle) or Ihat he/she is exempt �herefmm and the basis for �he allegetl exemption. Any viola�ion of Section 7031.5 6y
any applican� �or a permi� suUjects the applican� �o a civil Denal�y ol nol more ihan live hunOreO tlollars ($500�.
1, as owner ot ihe D�oDerty or my employees with wages as t�eir sole compensation. vnll Aa �he woh, ana the
❑ simcWre is not intenAeO or olfered for sale (Seclion 7044, Business antl Protessional Code: TAe Contractors' State License Law
aoes noi apply �o an owner ol a OroOe�Y w�o Ouilds or impmves Ihereon, an0 who does such work himselil�erseli or Ihrough
his or her own employees. pmvide0 that such impmvemen�s are noi in�entletl or o�teretl �or sale. I�, however �he buil0ing or
impmvemenl is soltl wi��in one year ol complelion, ��e owner vnll have Ue burtlen of pmving �e/she Aitl no� �ui10 or improve
, lor ihe purpose of sale).
I, as owner o� the pmDehy, am exclusively conUacting wi�h licensed contractors Io coretmc� �he pmject (Semion 7044, Business
ane Pmlessions Coae: The Conlraciors' Slaie License Law does not apply to an owner of propetly who builtls or impmve5 ihereon
antl who contracts lor such D�ole��s with a comracror(s) license Oursuant m ihe Coniractors' State License Law). I am zware
thal prool ol iheir Worker's Compensa�ion in5urance shoultl �e pmvidetl �o me.
� I am eremp� unaer Semion'. B. 8 P. C.
'�i �or Ihis Rason:
Daie: Ownec
I do �ereby rertify lhat l am aware of and unGers�and �he requiremenis of Calilorma Heal�h and Safery CoOe Sec�ions 25505, 25533. antl
2553d antl ��ai I or any fuWre building occu0anl willlwill no� (circle one) nee0lo comply wilh saitl siate codes antl t�e requiremen�s �or a
permii lor cons�mclmn or motlAica�ion imm Ihe Nir Oualiry Managemen� Oistric�. fleSiUen�ial constmction apP�ications are exempt fmm
��ese pmvisions.
�ate: AOPhcanl:
I here0y terlity �hai I have reatl �his apPlica�ion a Siate Iha� Ihe a�ove inlOrmalion is CorreCL I agree to comply with aIl tiiy and
ortlinances and Slale laws relaiing lo builtling co mc�ion antl �ereby aNhorize represenlatives ol lhis cily lo enter upan Ihe above�me
pmpetly �ar inspection purposes. /%/�
Da�e.� � � Signamre: � �,( ��lf��eTE�'3�
Oriver'S Lirense or Social Securily #: ��
�6at�46 Whne—Buildlna�, Green—CoOe EnlorcemenL Canarv—AoolicanL Pink—Revenue: Goltlenro�—Assessor
CITY OF COSTA MESA — BUZLDING PERMIT PERM NO; BP 05779
PERMIT NO: BP 057797 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE; PERMIT TYPE; PLU STR PURPOSE: ALT
JOB DESCRIPTION ; REPLACE SHOWER PAN SQ FT: 600
CLAIM VALUE; 600,00 CALC—VALUE; 600,00 GROUP OCC; R-3 /
COMMENTS: NO OTHER WORR PERMITTED
�r*�-**�� �*�***�*�t�*****�****�*x**�*�t�t�t��*�**�**�*****�x*�t*�t***�r*�r�*�t************
Z O N I N G R E Q U I R E M E N T S
ssTBacxs
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING RE • PROV; PARCEL: 92252119 ZNE: REF NO;
PLANNING N 1'ES>
�
iF if iE iF 1f iE IE it if iF �E iE iE �E iE jE if iE iE k�E 1E �E �E �f iE if 3f iF 1F �E �lE� iE �E �E iE 1E k iEif iE iF iE if iF iE iE �lEif af if jElE �E iE iE iFiE if if iE 3E fE df �E 3E iE IE k if * jE iF �1E If * iE if �f
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONTNG APPROVED BY DATE:
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY• DATE; ���
il�fiE�fikik�flflEiElFiE1F1E�EiflEififik�tlf�FiFiFiF3FiF'ififiF3FiF7E3FiF'iFiFi'F�fififiF iF3FiF3FiFiFiF3�'iFikif�fiE3EjflFiEif3f �1fdF
iE iE fE iE IE iE iF iE IE iE If �IElFiE iE if iE iF IE �k IE �E jF IF �FlF 3E iF if iF±F iE �ri� �E 3E 3F �E k IE iE �E iF if iE iE if if iEiE if iF �E iF 3f 1E 4 iEiE ik �E �E iE iE iE iF �F iE �E IE iE aE aE if if �/Fit%if iF
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIPIRES, " GRADING
PEAMIT 17.00 2.00 SO
2 5 Y SMIP /NOh7—RES
PLAN . "
ISSUE FEE 3.00 � y� '
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID �� DiiE
TOTALS----> 19,50 3,00 0.00 22,50 22,50 fr ,00
REVENUE DIVISION TOTALS--> COLLECTED; 22,50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING.:;PLAN—CHECK
17, 00 5. 00 , 50 � f'.-'
ik iE iE if ik iE if if iF iF 1F 3E �! 1E iF iE IE kiE i!!t iP if iE iE 1E iF 1P iF iF 3flE iF iE iFiE ik iE iE iE if 3f if 3f if iF ik if iE if iE if if ik iF ik 3E ik 1F iE iF iE ie iF iE if if �f �f if it if iE if if if iE iE K-
I N D I V I D U A li F E E B R E A K D O W N
TYPE (jTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 600 ALTER BY VALUE RESIDENTIAL N020NE 1,00 600,00
PLU 1 SHOWER 2,00 2,00
END OF FEES
EXF'IR��_
�ncomplete InsP�t�ons
Oete _a�--=�— Sig .._.---�----"`
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CONSTRUCTION AND PLANNING POOL & _
APPROVALS Permit # Date Inspector AppROVAIS Permit # Date Inspector
7. Temporary Eltctriwi Servire or Pole 52. Pool & Equipment Location �
2. Soil Pipe•Undrgmd. � 53. Sieel Reinforcement -
3. Electrical Conduit U�iliry-Undrgrnd. 54. Forms
� 4.�Electrical Goncluit�Undrgrnd. 55. Electrical Bonding
5.�Stee1 Reinforcement 56. Rough Plumbing & Pressure Test
6: .Electrical UF�R Gmd. � 57. APPROVAL TO COVER�GUNITE
7. Footings - ', 58. Electrical Conduit-Undrgrnd. �
S. Foundation . � 59. Gas Pipe, O Undrgrnd., Test
9'. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, CJ Undrgmd. .
10. Structural Floor System . ' 61. APPROVAL TO QECK -
71. Property Sewer Lin� & Hoc�se Connection 62. Backwash & Receptor�Finai
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Piumbing System � Final
14. flough Piumbing ' ,// • �� � � :7 ��� 65. Electricai-Final
//1 X- lt-7'�_�_l�_'if- //i !
15. Rough Electrical-Condu�t 66. Solar System-Final
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrlrzl-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19, Rough Heating & Air Conditloning FIRE DEPT. REQUIREMENT
20. �Rough Pactory Firepiace � � � _ ' APPROVALS Permit # -
21. .Ducts, in-$truCture., . , , " � �i70. Underground HYdro �
22. Ducts, V.entilating • ' � " 77. Product'Piping �'Gas ❑Oil
23.�Gas Pipe Rough & Yest � � i - 72, Underground Flush' ' �
24. �RooA Framing � � � � �73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof SHeathing �- ' � �, . �74. Overhead Hydro- � .
26. T-Bar Ceiling (Structuraq & Monocoat � 75. Dry Chemical - ,
27. �Frame and Flashing a ' 76. Dry Standpipe '. ' � . 3
28. Lathing & Sid�ng-. � - , - • . � 77. FIXED SYSTEM�FINAL
�29. Insulation � � � . � 78. FIRE PREV. fINAL � - • •
30. Drywall Nailing - HEALTH DEPT. REQUIREMENT .
31. Piaster Brown Coat- 79. FINAL INSPECTION �
32. Electrical�Power Meter-Finai .80..FOOD CERTIFICATE ISSUED
33. final Electric . Notes: � /� 9 / �
`'��� G�7.«�l�s-LYr�l l�o2h_<_Qz�unxLa'�
34. Finai Heating & Air Conditioning. - �� p����
_�� cut�ti�ct� �J.+r1�.r,g-�`7�!
35. Finai Gas Pipe-Test' � • d
36. Hood or CanoPY , , - �
�37. •Final Factory Fireplace ' ' �` ' : " '
38. Final Plumbing , � � , . '
39. WatAr Service�Final � � ��
40. Gas Service-Final , ,. ,- , , , '�
41. Solar pomestic-Pinal ' �
;, .
42. Backflow Preventer + , . ,
43. Backflow Irrigation � � � � .
� 44. Landscape Irr�9ation System� ' . ' � � �
45. Sound Attenuation �' E X P. � R c D
46. Handicap,Regulations ' _ P��� f15p2C �10115
47. FINAL STRUCTURE & BUtLDING � Slg _
48.�FINALPLANNING � � . .
49. Electric Release to Edison ' •r.
50. Gas fielease to Southern Cali(ornia Gas Co �
51. CERTIFICATE OFtOCCUPANCY �
No. Date
nr. xo.115-491-1ti LOT
INSPECTIONS
1 reround Soil iI G_ V
Gas
OCCUPANCY
DATE
DATE
FIAE ZONE DESCRIPTION OF
GROUP I TYPE V ZONE N-1
SUBCONTRACTOR I __ PERMITSISSUED__
Re
��
Form 210-SM-11.59 5-B P
12125
" � 1.2�2:i
EOSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 3f7 COBTA MEBA. CALIPORNIA
For Applieant to Fill In Complefely
TYPE OR PRINT
COSTA MESA CAIIFORNIA
7EL.
� 6ETBACK LINE FPOM
NO. OP BLDG6.
DESCRIPTION OF WORK
NO. OF ' �
ROOMS �/ 6TORIES
� EXTERIOR
L
i HEREBY ACKNOW68D08 THAT 1 HAVE NHAD TXIB �PPLIGTION
AND BTATE THAT TH8 ABOVB 18 COPRECT AND A6R8E TO COM•
PLY WITX ALL E�TY OR�INANCEB AND BTATH UW9 R60ULATINO
BUILDINO CONBYAUCTION. /�
81GNATURE OF���0���"�K/ K/L�[
� AUTHORIZED
�=E� R�CEiV��
"��� •5=�-3�bo
�IN�I�����r
APPLICATION ,,� n, �E�.'�
s�
BUILDING
For Office Use Only
qECE1PT NO. PERMIT NO.
/YiY�
RECEIV Y OATE HECEIVED OATE IBSUED/
�-1� ,5 -�3-Gdl ,r-. v3 ed
3UILDING � /J . S�.
4DDRE55 CGO U d"z�-K �
STA MESA.�ALIFORNIA
FIRE
ZONE TYPE G
APPROVEDn Wd�`"� G.pj G
BY /�J�///� DATE
ZONING
i NO. OF UBE OF N
I PLAN9 '� / BUILD�NG
1/
LGOAL �
D89CNIPTION
A.P.NO. u�S �� �I i
YARDS EVES
APPROVED ALLOWEC
(esnren uNe ar.� :^�
TH6 AMOUM BHOWN UNDER VALUATION IS POP THE
PURP08E OF E6TABLlBHING A PERMIT F£E ONLY.
�WATION �� __
� PERM17 FEE $ �
3, �3 � D �Y pLAN CHECK S fC �
TOTAL FEE $ / ��
7
GENERALCO:
AP. No. 115—�
INSPECTIONS
- ...._......a c
OCCUPANCY
DA
DATE
VALUE
ZONE DESCRIPTION
OUP ,I TYPE V ZONE R-1
SUBCONTRACTOR I _ __ �'ERMITSISSUED__
Form 210—SM-11-59 5-B P
, 1212�
`� .• yarn..lL.r`e`2
CbSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOl( 9f7 COBTA MEHA. CALIRORNIA
For Applieant fo Fill In Completely
YYPE OR PRINT
ADDRE'SS I C� o � ���o d—
COSTA MESA. CA IFORNIA
D
� ARCHITEGT
-.«�(% �.
STATE TEL.
LIC. NO. nnYf NO.
SIZE �� � /DO NO. OP B1D09.
OF LOT NOW oN �oT
�sE�.°.F„- e...,. /i' L� S
■ 96TBAC1{ LINE FROM
I S,ZE DING • / � /
OF WORK
ROOF
'CO GOVERII
WORK TO BE
I HEPHBY ACKNOWL8C�6 TMAT 1 XAV6 RBAD TH18 APPLIGTION
AND BTAT¢ TH�T TH6 �B�Ve IB CORPECT AND AORBE TO COM-
PLY WITH ALL CITY O�INANCEB AND BT/�TE LAWB R6OULATNO
BUILDINO CONOTRUGTIO ��
81GNATURE OF
PERMITTE
AUTHORIZED AGENT'
C=EE RECEIVE�
.k� �. y -.� 3 - � o
APPLICATiQ�A�iOR �T�T
"^„ "r "^4TA MF.S11
S � BUILDING
For Office Use Only
RECEIPT NO, vlFMIT NO.
%:L /3�5�
RECE EO OY DATE RECEIVED f OATE 198UED/
� -�3—�01 �-y3—(�c
BUILDING p c
ADDRESS � v � LG�l°-�-el.- d �
COSTA MES . CALIFORNIA
ZONING
�� I NO. OF 1� I U8E OF N
PLANB �� BWLOINO
LEOAL l I l
YARDS � �
APPROVED
�cae�rea un¢ er.�
APPROVED
TXE AMOUNT BXOWN UNDER VALf1ATION �8 FOR TH!
PUItP09E OR ESTA9L19HIN6 A PfipMIT FEE ONIY.
VALUATION
/ /L/D � PERMIT FEE $ �,/�
$ J PLAN CHECK $ I
TOTAL FEE $ �o"`�
�
ORANGE COUNTY BUILDING DEPARTMENT
j' 636 North Broadway � � '
% SqNTA ANA, CALIFORNIA
Y�
FOR APPLICANT TO FILL IN
BUILDING
AODftE55 � D(�p{�t(](�(� S+
..d uy
SCHOOL DIST. COS UH Me sa
OR TOWN
NEAREST
cRoss ST. Mnnwn�.i e
cin
ARCHITE�
ENGINEEI
ADDRE55
CONTRAC
ADORE55
stuio' 13�iAA2
-Beverls Hill
K I TRACT 1712
IATTACH METES g BOUND51
NO. OF BLDGS.
SIZE OF LOT 72 R ZOO NOW ON LOT O
USE OF I NO. OF I NO. OF
E%ISTING BLDG. FAN.ILI[3 RO
CENBTER OF'STR[ET"'� 50 ft� SEDE YARDZO �
D�SCRIPTION OF WORK
NEW I xI pLTERATION I I pDDIT10N
PEPAIR I I MOVING I I DEMOLISM
EXTERIOR WALL I ROOF
COVERING Stp(�(�(� COVEi
USE OF NEW
euaoirvc ppalAanna—Gtt
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AryD STATE THAT THE ABOVE IS GORREGT
AND AGREE TO COMPLY WITH AlL GOUNTY ORDINANCES
AND STATE LAW6 REGULATING BUILOING CONSTRUCTION.
SIGNATURE OF
PERMITTE N
AUTHORIZED AG
APPLICATION FOR PERMIT
Bui�Di�� 1
FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
�.�31 a�� j_ r/
BY DqTE REC'D. DATE ISSIiED
�--� -J�.� i g-3-��
BUfLDING (�QO/
ADDRE55 � �
SCHOOL DIST.
OR TOWN
NEAREST
CRO55 5T.
ZONE N . i
A�{ / PlANS
EXT.
r. .
CORRECTIONS
APPROVALS
PEaMIT F[E $ � MASONRY REINFORCED
VALUATION 5�5902�00 p��H CHecK 3
L BONO BEAM
FEEAL /T FINAL
/I
0
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PLOT PL•AN , , � . _ - -
Show location and distances from
property line and between buildings. - _. .
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